All About Care (South West) Limited is a domiciliary care agency providing personal care. The service provides support to people who live in their own homes. At the time of our inspection there were 30 people using the service. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided such as medicines. At our last inspection we found staff had not always been provided with adequate training and supervision. Risk assessments, care plans and mental capacity assessments were not in place and effective governance systems were not in place to ensure oversight and the safe care and treatment of people using the service. This resulted in breaches of regulations relating to the need for consent, safe care and treatment and good governance. At this inspection we found enough improvements had been made and the service was no longer in breaches of regulations.
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All About Care (South West) Limited received an overall rating of Requires Improvement following a July 2023 inspection, with breaches of Regulations 11, 12 and 17 identified relating to consent, safe care and treatment, and governance—including unsafe medicines management, absent risk assessments, and ineffective oversight inherited from the previous management team. The newly acquired management team demonstrated openness and had begun remedial action, and staff were consistently described as kind and caring, securing a Good rating for caring.
Concerns (11)
criticalMedication management — “A person had not received 1 medicine for at least 11 days due to running out of stock. This had not been identified by the service and no actions had been taken.”
criticalMedication management — “MAR did not always include the date of administration, the prescriber's instructions for how and when the medicine should be taken and which route the medicine should be administered.”
criticalConsent / capacity — “5 out of the 6 care plans we reviewed did not have a signed consent to care in place. Where people lacked capacity, mental capacity assessments had not been completed.”
criticalStaff training — “I had no experience of mobility aids/hoists, hazards and risks yet I was expected to care with no training in place at all.”
criticalStaff competency — “Staff had not always been assessed as competent to administer medicines. At the time of our inspection, 2 out of 13 staff had been assessed.”
criticalGovernance — “Governance systems and processes were either not in place or effective at identifying areas of improvement. This meant quality performance had not always been assessed.”
criticalSafeguarding — “Incidents that affected the health, safety and welfare of people using the service had not always been reported internally and to the relevant external authorities/bodies.”
moderateCare planning — “The care plans have been terrible and some years out of date, no information at all, we have been blind. They are slowly being sorted out.”
moderateSupervision / appraisal — “Staff told us they felt supported however, they had not received regular supervisions and appraisals.”
moderateIncident learning — “The nominated individual told us there had not been a lessons learned process in place and they were working to establish a system to ensure learning in the future.”
moderateRecord keeping — “Risk assessments had not been completed to assess people's susceptibility to infections and any potential risk of harm from their environments.”
Strengths
· People told us they felt safe and felt well cared for by staff who were kind and caring.
· Staff had been recruited safely into the service with checks including full employment history, references and DBS checks.
· Infection prevention and control procedures were in place and robust with adequate PPE supplies.
· New management team was open and honest throughout the inspection and proactively identified issues.
· Pre-assessments had been completed for every person who started using the service from May 2023.
Quality-Statement breakdown (20)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversity; Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Meeting people's communication needsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Working in partnership with othersRequires improvement